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Antibiotic-associated diarrheaBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/antibiotic-associated-diarrhea/DS00454
Antibiotic-associated diarrhea describes frequent, watery bowel movements (diarrhea) that occur in response to medications used to treat bacterial infections (antibiotics).
Most often, antibiotic-associated diarrhea is mild and clears up shortly after you stop taking the antibiotic. But in some cases, antibiotic-associated diarrhea leads to colitis, an inflammation of your colon, or a more serious form of colitis called pseudomembranous colitis. Both can cause abdominal pain, fever and bloody diarrhea.
Mild antibiotic-associated diarrhea may not require treatment. More serious antibiotic-associated diarrhea may require stopping or switching antibiotic medications.
Antibiotic-associated diarrhea can cause signs and symptoms that range from mild to severe.
Common signs and symptoms
For most people, antibiotic-associated diarrhea causes mild signs and symptoms, such as:
- Loose stools
- More-frequent bowel movements
Antibiotic-associated diarrhea is likely to begin about a week after you start the antibiotic therapy. Sometimes, however, diarrhea and other symptoms may not appear for days or even weeks after you've finished antibiotic treatment.
More-serious signs and symptoms
Some people experience a more serious form of antibiotic-associated diarrhea. When the overgrowth of harmful bacteria is severe, you may have signs and symptoms of colitis or pseudomembranous colitis, such as:
- Frequent, watery diarrhea
- Abdominal pain and cramping
- Mucus in your stool
- Bloody stools
- Loss of appetite
When to see a doctor
Call your doctor right away if you experience signs and symptoms of serious antibiotic-associated diarrhea. These signs and symptoms are common to a number of conditions, so your doctor may recommend tests to determine the cause.
Antibiotic-associated diarrhea occurs when antibacterial medications (antibiotics) upset the balance of good and bad bacteria in your gastrointestinal tract.
The antibiotics most likely to cause diarrhea
Nearly all antibiotics can cause antibiotic-associated diarrhea, colitis or pseudomembranous colitis. The antibiotics most commonly linked to antibiotic-associated diarrhea include:
- Cephalosporins, such as cefixime (Suprax) and cefpodoxime
- Clindamycin (Cleocin)
- Penicillins, such as amoxicillin (Amoxil, Larotid, others) and ampicillin
- Fluoroquinolones, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin)
How antibiotics cause diarrhea
Your digestive tract is a complex ecosystem that's home to millions of microorganisms (intestinal flora), including hundreds of species of bacteria. Many of these bacteria are beneficial, performing essential functions.
But some of the bacteria that normally inhabit your intestinal tract are potentially dangerous. These harmful bacteria are usually kept in check by beneficial bacteria unless the delicate balance between the two is disturbed by illness, medications or other factors.
Antibiotics can be especially disruptive to intestinal flora because they destroy beneficial bacteria along with harmful ones. Sometimes, without enough "good" microorganisms, "bad" bacteria that are resistant to the antibiotic you received grow out of control, producing toxins that can damage the bowel wall and trigger inflammation.
Clostridium difficile causes most serious antibiotic-associated diarrhea
The bacterium responsible for almost all cases of pseudomembranous colitis and many instances of severe antibiotic-associated diarrhea is C. difficile. Most people acquire a C. difficile infection during a stay in a hospital or nursing home after they've received antibiotics.
Antibiotic-associated diarrhea can occur in anyone who undergoes antibiotic therapy. But you're more likely to develop antibiotic-associated diarrhea if you:
- Have had antibiotic-associated diarrhea in the past, have taken antibiotic medications for an extended period of time or are taking more than one antibiotic medication
- Are age 65 or older
- Have had surgery on your intestinal tract
- Have recently stayed in a hospital or nursing home
- Have a serious underlying illness affecting your intestines, such as inflammatory bowel disease, Crohn's disease or celiac disease
The most severe form of antibiotic-associated diarrhea, pseudomembranous colitis, can rarely lead to life-threatening complications, including:
- Dehydration. Severe diarrhea can lead to excessive loss of fluids and electrolytes — essential substances such as sodium and potassium. Extreme fluid loss can cause serious complications. Signs and symptoms of dehydration include a very dry mouth, intense thirst, little or no urination, and extreme weakness.
- A hole in your bowel (bowel perforation). Extensive damage to the lining of your large intestine can lead to a perforation in the wall of your intestine, requiring surgery to repair the hole.
- Toxic megacolon. In this condition, your colon becomes unable to expel gas and stool, causing it to become greatly distended (megacolon). Signs and symptoms of toxic megacolon include abdominal pain and swelling, fever, and weakness. Toxic megacolon is a serious complication that can lead to infection or a ruptured colon. Toxic megacolon requires aggressive treatment, usually with medications or possibly surgery.
- Death. Severe complications caused by antibiotic-associated diarrhea can result in death.
Preparing for your appointment
Start by seeing your family doctor or a general practitioner if you have signs or symptoms of antibiotic-associated diarrhea. Your doctor will investigate the potential causes of your signs and symptoms.
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready, and what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes. If you've recently stayed in the hospital or in a nursing home, include that, too.
- Make a list of all medications, as well as any vitamins or supplements that you're taking. If you've recently taken antibiotics, include that information in your medications list.
- Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For antibiotic-associated diarrhea, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- What are other possible causes for my symptoms or condition?
- What kinds of tests do I need?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- What are the alternatives to the primary approach that you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
- What will determine whether I should plan for a follow-up visit?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions that occur to you during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- Are you currently taking or have you recently taken antibiotics?
- Have you stayed in a hospital or nursing home recently?
- Do you have a history of intestinal problems such as ulcerative colitis, Crohn's disease or other inflammatory bowel disease?
- Have you been around anyone who has been sick with diarrhea in the recent past?
What you can do in the meantime
Continue taking your antibiotics as directed by your doctor.
To cope with diarrhea until your appointment, you can:
- Drink more water and other liquids to replace fluids lost because of diarrhea.
- Eat soft, bland foods and avoid spicy or greasy foods that can aggravate diarrhea.
- Eat several small meals, rather than a few larger meals.
Tests and diagnosis
To diagnose antibiotic-associated diarrhea, your doctor may:
- Ask questions about your health history. Expect your doctor to ask about your medical history, including whether you've had recent hospitalizations or antibiotic treatments.
- Analyze a stool sample. If your symptoms are severe, you may be asked to provide samples of your stool. Stool samples can be tested in a laboratory to determine which bacteria are causing your antibiotic-associated diarrhea. This can help your doctor select the proper treatment.
Treatments and drugs
Treatment for antibiotic-associated diarrhea depends on the severity of your signs and symptoms.
Treatments to cope with mild antibiotic-associated diarrhea
If you have mild diarrhea, your symptoms may clear up within a few days after your antibiotic treatment ends. In some cases your doctor may advise you to stop your antibiotic therapy until your diarrhea subsides. In the meantime, your doctor may recommend home care techniques to help you cope with diarrhea until it resolves on its own.
Treatment to fight harmful bacteria in severe antibiotic-associated diarrhea
If you experience colitis or pseudomembranous colitis, your doctor may prescribed antibiotics to kill the harmful bacteria causing your antibiotic-associated diarrhea. For many people, this approach will clear up signs and symptoms. For those with pseudomembranous colitis, diarrhea symptoms may return and require repeated treatment.
Lifestyle and home remedies
To cope with diarrhea, try to:
- Drink plenty of fluids. Water is best, but fluids with added sodium and potassium (electrolytes) may be beneficial as well. Try drinking broth or watered down fruit juice. Avoid beverages that are high in sugar or contain alcohol or caffeine, such as coffee, tea and colas, which may aggravate your symptoms.
- Choose soft, easy-to-digest foods. These include applesauce, bananas and rice. Avoid high-fiber foods such as beans, nuts and vegetables. If you feel like your symptoms are improving, slowly add high-fiber foods back to your diet.
Take probiotics. Probiotics are organisms, such as bacteria and yeast, that can help restore a healthy balance to the intestinal tract by boosting the level of good bacteria to help defeat the harmful bacteria. Probiotics are available in capsule or liquid form and are also added to some foods, such as certain brands of yogurt.
Studies confirm that some probiotics, including Lactobacillus rhamnosus and Saccharomyces boulardii, used in conjunction with antibiotics may be helpful as a treatment for antibiotic-associated diarrhea. However, further research is needed to better understand which strains of bacteria are most helpful or what doses are needed.
- Try eating several small meals, rather than a few large meals. Space meals throughout the day instead of eating two or three large ones.
- Avoid irritating foods. Stay away from spicy, fatty or fried foods and any other foods that make your symptoms worse.
- Ask about anti-diarrheal medications. In some cases of mild antibiotic-associated diarrhea, your doctor may recommend anti-diarrhea medications, such as loperamide (Imodium A-D). But check with your doctor first before taking anti-diarrheal medications because they can interfere with your body's ability to eliminate toxins and lead to serious complications.
To help prevent antibiotic-associated diarrhea, try to:
- Take antibiotics only when necessary. Limit your antibiotic use and don't use antibiotics unless you and your doctor feel they're absolutely necessary. For instance, antibiotics can treat bacterial infections, but they won't help viral infections, such as colds and flu.
- Ask caregivers to wash their hands. If you're hospitalized, ask each person you come in contact with to wash his or her hands before touching you. This may reduce the risk that you'll come in contact with C. difficile, the bacterium that can cause serious antibiotic-associated diarrhea.
- Tell your doctor if you've experienced antibiotic-associated diarrhea in the past. Having antibiotic-associated diarrhea once increases the chance that antibiotics may cause that same reaction again. Your doctor may select an antibiotic that is less likely to cause diarrhea.
Consider probiotics if you've had antibiotic-associated diarrhea in the past. Probiotics are concentrated supplements of beneficial organisms, such as bacteria and yeast, that you take in capsule or liquid form. Some yogurts and other foods also contain probiotics.
Some evidence suggests that taking probiotics during antibiotic treatment may reduce the risk of diarrhea in people who've had antibiotic-associated diarrhea caused by C. difficile in the past. Some studies haven't found probiotics to be useful. Ask your doctor about whether probiotics could help you.
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